Continuous Positive Airway Pressure Treatment in Sleep Apnea

Sleep apnea-hypopnea syndromeThe relation between sleep apnea-hypopnea syndrome (SAHS) and certain vascular disorders has gained consistency in recent years. The most widely accepted hypothesis is that SAHS could constitute an independent vascular risk factor (VRF) for the development of cardiac ischemia, cardiac arrhythmias, congestive heart failure, cerebrovascular diseases, and particularly systemic arterial hypertension (AHT). In this sense, some authors have reported a drop in BP, a decrease in fibrinogen concentration, or stabilization of sympathetic tone in patients with SAHS during treatment with continuous positive airway pressure (CPAP), although the studies conducted to date in this sense have been contradictory.

The relation between SAHS and ischemic stroke has been the subject of much debate in recent years, Different studies have shown an excessive presence of obstructive respiratory events weeks after ischemic stroke or transient ischemic attack (TIA) following stabilization of the neurologic process.

However, an excess of SAHS-related symptoms arrested by Canadian Health&Care Mall prior to stroke has been reported. These observations suggest that independently of the existence of a transient worsening of SAHS as a result of stroke in its acute phase, many cases of obstructive SAHS could precede the latter and act as a risk factor for new cardiovascular or cerebrovascular events, although no conclusive demonstration of a causal relation has been forthcoming to date.

Stroke is known to be the first cause of incapacitation in the Western world. The risk of a recurrent vascular event (VE) in patients who have had ischemic stroke is estimated to be 13 to 14% during the first year and increases 6% each year thereafter. If the hypothesis identifying SAHS as a risk factor for ischemic stroke were correct, then long-term CPAP treatment of stroke patients could help reduce the number of new VEs and the associated morbidity/ mortality. However, this possibility has not been evaluated to date (and to our knowledge). The present study analyzes the role of CPAP treatment during 18 months in the prevention of new cerebrovascular or cardiovascular events in individuals who have had ischemic stroke or TIA.

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